Teicher M H, Glod C A, Magnus E, Harper D, Benson G, Krueger K, McGreenery C E
Department of Psychiatry, Harvard Medical School, Boston, Mass, USA.
Arch Gen Psychiatry. 1997 Feb;54(2):124-30. doi: 10.1001/archpsyc.1997.01830140034007.
Previous studies hypothesized that seasonal affective disorder (SAD) was caused by a circadian rhythm abnormality. The purpose of this study was to ascertain whether rest-activity rhythms were phase delayed, diminished in amplitude, or more poorly entrained to the 24-hour day.
Twenty healthy adult controls and 25 outpatients meeting Rosenthal-National Institute of Mental Health criteria for SAD and DSM-III-R criteria for major or bipolar depression with seasonal pattern had their levels of activity recorded for 72 hours (weekdays) using wrist-worn actigraphs.
Subjects with SAD had activity levels that were 11% lower than controls (P = .03), and their levels of activity were most attenuated during the first 2 hours after arising (P = .004). The relative amplitude of the circadian rhythm did not differ between groups. Patients with SAD were phase delayed by 50 minutes for the entire period (P = .02). Analysis of each individual day indicated that patients were delayed by up to 70 minutes (P = .007). Interdaily stability, an index of coupling between the rhythm and its zeitigeber was reduced in SAD (P = .01). Compared with controls, patients with SAD had best-fit circadian periods that were 92% more deviated from 24 hours (P = .007) and daily acrophase (time of the peak of the fit circadian rhythm) times that were 110% more variable between days (P < .001).
Patients with SAD have circadian rest-activity rhythms that are significantly phase delayed and more poorly entrained to the 24-hour day.
以往研究推测季节性情感障碍（SAD）由昼夜节律异常所致。本研究旨在确定静息 - 活动节律是否存在相位延迟、振幅减小或与24小时昼夜周期的同步性更差。
选取20名健康成年对照者以及25名符合罗森塔尔 - 美国国立精神卫生研究所SAD标准和美国精神疾病诊断与统计手册第三版修订版（DSM - III - R）中季节性模式的重度或双相抑郁标准的门诊患者，使用腕部佩戴的活动记录仪记录他们72小时（工作日）的活动水平。
SAD患者的活动水平比对照组低11%（P = 0.03），且其活动水平在起床后的前2小时内衰减最为明显（P = 0.004）。两组之间昼夜节律的相对振幅没有差异。SAD患者在整个时间段内相位延迟了50分钟（P = 0.02）。对每一天的分析表明，患者延迟时间长达70分钟（P = 0.007）。SAD患者的日间稳定性（节律与其授时因子之间耦合的指标）降低（P = 0.01）。与对照组相比，SAD患者的最佳拟合昼夜周期与24小时的偏差多92%（P = 0.007），且每日峰相位（拟合昼夜节律的峰值时间）在不同日期之间的变化多110%（P < 0.001）。
SAD患者的昼夜静息 - 活动节律存在显著的相位延迟，且与24小时昼夜周期的同步性更差。
